Strategies for Identifying and Addressing Unprofessional ......Program for Distressed Physicians 226...
Transcript of Strategies for Identifying and Addressing Unprofessional ......Program for Distressed Physicians 226...
Strategies for Identifying and Addressing Unprofessional Physician Behavior
William H. Swiggart, MS
Assistant in Medicine
Vanderbilt Department of Medicine
Co-Director, Center for Professional Health
Vanderbilt University Medical Center
Nashville, TN
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
I have no financial relationships to disclose.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Describe the Center for Professional Health
Program for Distressed Physicians
professional development course and lessons
learned.
Explore specific approaches to remediation
and skill building.
Identify resources.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
► Describe the etiology of unprofessional behavior.
► Complete one self-assessment tool and evaluate the results.
► Practice at least two grounding techniques. ► State the “8:1” ratio. ► Define “flooding”
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Course N Years
Maintaining Proper Boundaries 970 2000-2016
Program for Distressed
Physicians
226 2004-2016
Proper Prescribing of Controlled
Prescription Drugs
1246 1994-2016
Proper Prescribing of Controlled
Prescription Drugs for APRNs
16 2015-2016
TOTAL 2458 1998-2016
Updated January, 2017 Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Site Dates Participants Vanderbilt University Medical Center
Center for Professional Health
Nashville, TN
William H. Swiggart, M.S.
www.mc.vanderbilt.edu/cph
2004-2016 226
University of Florida College of Medicine
Gainesville, FL
Dr. Martha Brown
www.drmarthabrown.com
2011-2016 142
Rush/Professional Renewal Center
Chicago, IL and Lawrence, KS
Drs. Betsy and Michael Williams
http://prckansas.org/cme/the-program-for-distressed-
physicians-cme-course-overview
2015-2106 74
University of Virginia
Charlottesville, VA
Dr. John Schorling and Dr. Kim Penberthy
https://med.virginia.edu/psychiatry/patients/eccs/eccs-
course-description/
2011-2015
46
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
“We judge ourselves by our motives,
others judge us by our behavior.” - AA quote
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
► “Intimidating and unprofessional behavior can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.”
-- Sentinel Event Alert, Issue 40: Behaviors that Undermine a Culture of
Safety. Joint Commission, September 2016. https://www.jointcommission.
org/sentinel_event_alert_issue_40_behaviors_that_undermine_a_
culture_of_safety/
► Misprescribing
► Boundary issues sexual and other
Williams BW, Swiggart WH, Ghulyan MA, Vickers, K, Williams MV.
FSPHP April 23-26, 2012
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Aggressive
Anger Outbursts
Profane/Disrespectful
Language
Throwing Objects
Demeaning Behavior
Physical Aggression
Sexual Comments or
Harassment
Racial/Ethnic Jokes
Passive
Aggressive
Derogatory
comments about
institution, hospital,
group, etc.
Refusing to do tasks
Passive
Chronically late
Not responding to calls
Inappropriate or
inadequate chart notes
Spectrum of Disruptive Behaviors
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
“The Perfect Storm”
Physician Hospital/Clinic
The external system The internal system
Good skills
Poor skills
Functional & nurturing
Dysfunctional
Developed by: William H. Swiggart, MS.
Center for Professional Health at Vanderbilt
University Medical Center, 2017. © All rights
reserved.
Institutional Factors*
◦Scapegoats
◦System reinforces behavior
◦ Individual pathology may over-
shadow institutional pathology.
* Williams and Williams, 2004
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Individual Factors
◦ Predisposing Psychological Factors1
Alcohol and Drug Family History
Trauma History
Religious Fundamentalism
Familial High Achievement
◦ Personality Traits2
Narcissism
Obsessive/Compulsive
◦ Physician Burnout3
◦ Clinical Skills Satisfactory or Above Average4 1. Valliant, 1972 2. Gabbard, 1985
3. Spickard and Gabbe, 2002 4. Papadakis, 2004, 2005
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
“This means you feel so stressed that you
become emotionally and physically
overwhelmed…”
“Pounding heart, sweaty hands, and shallow
breathing.”
“When you’re in this state of mind…you are not
capable of hearing new information or accepting
influence.”
*John M. Gottman, Ph.D. The Relationship
Cure, Crown Publishers, New York, 2001, 74-78.
Flooding
Test
See handouts
Copyright, John M. Gottman, All Rights Reserved (revised 11/17/03)
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Scoring: If you answered “yes” to more than eight
statements, this is a strong sign that you are prone to
feeling flooded during conflict. Because this state can be
harmful to you, it’s important to let others know how you
are feeling. The antidote to flooding is to practice soothing
yourself.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
“This means you feel so stressed that you
become emotionally and physically
overwhelmed…”
“Pounding heart, sweaty hands, and shallow
breathing.”
“When you’re in this state of mind…you are not
capable of hearing new information or accepting
influence.”
*John M. Gottman, Ph.D. The Relationship Cure, Crown
Publishers, New York, 2001, 74-78.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
GROUNDING
Categories exercise
Judge versus describe
Breathe
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
SPECIFIC PHRASES
You may be right.
Give me a minute, I’ll get right back to you.
I know this may be frustrating, I want to address
your concerns.
Tell me how I can help you.
Glad you are here.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Cannot change their behavior.
Do not care about others.
Enjoy conflict.
Being a good surgeon excuses poor
communication.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Mr. Bangsiding felt (and wrongly so) that a little
chat would be enough to stop Bob’s disruptive behavior.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
► Distressed physicians lack the skills to be effective.
► Sometimes unprofessional behavior may be directly linked to the work environment.
► Distressed physicians often carry the concerns of their colleagues alone and fail to get consensus when dealing with administration.
► Physicians noted as “most helpful:” ○ Role play ○ Grounding skills ○ Follow-up small groups and genogram
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
►Distressed physicians are often introverted in
nature which can lead to poor communication.
►Distressed physicians don’t understand the “8:1”
positive-to-negative ratio.
Physicians may not ask enough questions when
taking a new leadership position. (Orthopedic
surgeon story)
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Distressed physicians often come from families that
were rigid and disengaged.
Change takes time and feedback (B-29© survey).
Distressed physicians tend to speed up under stress.
Distressed physicians tend to flood and fail to
recognize their own flooding as well as flooding in
others.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Courses
Coaches, counselors
Comprehensive evals
360° Evaluations
Physician Wellness
State BME
Professional Societies
QI Officers
EAP
State Physician Health
Programs
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Vanderbilt Center
for
Professional Health
Professional Development Courses Today’s slides can be found on our website below
www.mc.vanderbilt.edu/cph
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.
Developed by: William H. Swiggart, MS. Center for Professional Health
at Vanderbilt University Medical Center, 2017. © All rights reserved.